Patients who relapse after first-line therapy are incurable. The majority of patients relapse within 12 months and the length of the treatment-free interval before relapse is an important factor in predicting response to second-line therapy. People with a treatment-free interval of greater than 12 months should be re-challenged with a platinum-containing regimen. Other indicators of response are the bulk of disease, previous response to treatment, and the number of disease sites.
A number of new agents including topotecan, liposomal doxo-rubicin, etoposide, gemcitabine, and altretamine have response rates of 15-25% in this setting.
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